Eliciting tacit knowledge: The potential of a&amp;nbsp;reflective approach to video-stimulated interviewing

Braak, Marije van; Groot, Esther de; Veen, Mario; Welink, Lisanne; Giroldi, Esther

doi:10.1007/s40037-018-0487-9

Cited by 27 publications

(23 citation statements)

References 34 publications

(86 reference statements)

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“…Every interview, we started with listening to an audiotape of a telephone triage conversation. This technique helps the participant to give meaning to and reflect on their behaviour in a real‐life situation (van Braak, de Groot, Veen, Welink, & Giroldi, ). A topic list comprised of open questions about clinical reasoning and working with the CDSS was used as a framework (Appendix 2).…”

Section: Methodsmentioning

confidence: 99%

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Wouters

Zwart

Erkelens

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To understand clinical reasoning and decision‐making of triage nurses during telephone conversations with callers suspected of having acute cardiac events, and support from a computer decision support system (CDSS) herewith. Background In telephone triage, nurses assess the urgency of callers’ conditions with clinical reasoning, often supported by CDSS. The use of CDSS may trigger interactional workability dilemmas. Design Qualitative study using principles of a grounded theory approach following COREQ criteria for qualitative research. Methods Audio‐stimulated recall interviews were conducted amongst twenty‐four telephone triage nurses at nine out‐of‐hours primary care centres (OHS‐PC). Results Telephone triage nurses use clinical reasoning elements for urgency assessment. Typically in telephone triage, they interpret the vocal—but not worded—elements in communication (paralanguage) such as tone of voice and shortness of breath and create a mental image to compensate for lack of visual information. We confirmed that interactional workability dilemmas occur. Congruence, established when the CDSS supports the triage nurses’ decision‐making, is essential for the CDSS’ value. If congruence is absent, triage nurses may apply four working strategies: (a) tinker to make CDSS final recommendation align with their own assessment, (b) overrule the CDSS recommendation, (c) comply with the CDSS recommendation or (d) transfer responsibility to the GP. Conclusion Triage nurses who assess urgency may experience absence of congruence between the CDSS and their decision‐making. Awareness of how triage nurses reason and make decisions about urgency and what aspects influence their working strategies can help in achieving optimal triage of callers suspected of acute cardiac events at OHS‐PC. Relevance to clinical practice Triage nurses’ reasoning and their working strategies are vital for outcome of triage decisions. Understanding these processes is essential for CDSS developers and OHS‐PC managers, who should value how triage nurses interact with the CDSS, while they have the benefit of callers in mind.

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Section: Methodsmentioning

confidence: 99%

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Wouters

Zwart

Erkelens

et al. 2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

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“…And because of the time delay between the video-recording and the interview there could be some alterations in the recall of why certain prescribing decisions were made. Although accurate recall of cognitive process could have been altered, the reflection on the behaviour elicited in the moment of interviewing are equally important [17].…”

Section: Strengths and Weaknesses/limitationsmentioning

confidence: 99%

“…A video of their consultation was used as a prompt to explore tacit knowledge (that what they know but find difficult to describe) [16], beliefs, attitudes, social influences, communication, etc. that drove their behavior [17]. To improve antibiotic prescribing quality in this specific setting, better understanding of GPs' beliefs in action on their antibiotic prescribing decision-making is crucial to inform the development of effective interventions, create awareness and guide changes in attitudes and practices.…”

Section: Introductionmentioning

confidence: 99%

Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study

et al. 2020

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Infections are the most common reason why patients consult out-of-hours (OOH) primary care. Too often there is an overprescribing of antibiotics for self-limiting infections and general practitioners (GPs) do not always choose the guideline recommended antibiotics. To improve antibiotic prescribing quality, a better understanding is needed of the (non) antibiotic prescribing decisions of GPs. This study sets out to unravel GPs’ (non) antibiotic prescribing decisions in OOH primary care. We video-recorded 160 consultations on infections during OOH primary care by 21 GPs and performed video-elicitation interviews with each GP. GPs reflected on their decision-making process and communication while watching their consultation. A qualitative thematic analysis was used. GPs found that their (non) antibiotic prescribing decision-making was not only based on objective arguments, but also subconsciously influenced by their own interpretation of information. Often GPs made assumptions (about for example the patients’ reason for encounter or expectations for antibiotics) without objectifying or verifying this with the patient. From the beginning of the consultation GPs follow a dichotomous thinking process: urgent versus not urgent, viral versus bacterial, antibiotics versus no antibiotics. Safety-netting is an important but difficult tool in the OOH care context, with no long-term follow-up or relationship with the patient. GPs talk about strategies they use to talk about diagnostic uncertainty, what patients can expect or should do when things do not improve and the difficulties they encounter while doing this. This video- elicitation interview study provides actionable insights in GPs’ (non) antibiotic prescribing decisions during OOH consultations on infections.

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“…The medical content of a consultation was never a selection criterion. To enhance recall, the semi-structured VSI were scheduled to take place within two weeks of the recordings [23][24][25][26]. The interviews followed a guide developed and iteratively revised by the research team (Additional file 1).…”

Section: Data Collectionmentioning

confidence: 99%

“…Secondly, this study used VSI to collect data on thought processes during decision-making. This method encourages reflection, deepens the interview and can overcome recall bias [23][24][25]30]. VSI is a very efficient way to discuss concrete considerations, thoughts and perceptions linked to a specific moment and thus minimise socially desirable answers that might be given if we had taken a more general or abstract approach to the topic.…”

Section: Strengths and Limitations Strengthsmentioning

confidence: 99%

Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

et al. 2020

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Background: Evidence-based medicine (EBM) in general practice involves applying a complex combination of bestavailable evidence, the patient's preferences and the general practitioner's (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other's consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other's EBM behaviour through observation, and by identifying aspects that influence their recognition. Methods:We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner's consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner's actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other's considerations well with those who did not, we developed a model describing the aspects that influence the observer's recognition of an actor's EBM behaviour.Results: Overall, there was moderate similarity between an actor's EBM behaviour and the observer's recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role.Conclusions: GP trainees and supervisors do not fully recognise EBM behaviour through observing each other's consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decisionmaking is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.

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Eliciting tacit knowledge: The potential of a reflective approach to video-stimulated interviewing

Abstract: None

Cited by 27 publications

References 34 publications

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study

Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

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